patient with generalized anxiety disorder (GAD) and the role of corticotropin-releasing hormone (CRH) dysregulation: Cholecystokinin

January 14, 2024by Dr. S. F. Czar0

 Case study


  • Name: Sarah Mitchell
  • Age: 28 years
  • Gender: Female
  • Occupation: Marketing Manager
  • Chief Complaint: Persistent and excessive worrying, restlessness, and physical symptoms of anxiety.
Presenting Symptoms:
  • Sarah reported ongoing and excessive worrying about various aspects of her life, including work, relationships, and her health. She often described these worries as uncontrollable and intrusive.
  • She experienced physical symptoms of anxiety, such as muscle tension, restlessness, and fatigue.
  • Sarah mentioned that her anxiety had significantly affected her work performance, causing difficulty in concentrating and making decisions.
  • She also had difficulty falling asleep and maintaining restful sleep due to racing thoughts.
Medical History:
  • Sarah had no significant medical history or family history of anxiety disorders.
  • She denied any recent illnesses, surgeries, or medication use.
Psychological Assessment:
  • Sarah underwent a psychological assessment, which included structured interviews and self-report questionnaires. Her responses indicated the presence of generalized anxiety disorder (GAD).
Hormonal Assessment:
  • Hormonal assays were conducted to assess cortisol levels and evaluate the functioning of the HPA axis.
  • Sarah’s cortisol levels were measured under baseline conditions and in response to a mild stressor, such as a public speaking task.
  • Her cortisol levels exhibited a heightened response to stress, suggesting dysregulation of the HPA axis.
  • Based on the clinical presentation, psychological assessment, and hormonal testing, Sarah was diagnosed with generalized anxiety disorder (GAD) characterized by HPA axis dysregulation.
  • Sarah’s treatment plan included a combination of psychotherapy and stress management techniques:
    • Cognitive-Behavioral Therapy (CBT): Sarah participated in CBT sessions to address her maladaptive thought patterns and behaviors associated with anxiety. She learned strategies to challenge and reframe her worrying thoughts.
    • Stress Reduction Techniques: Sarah was taught stress reduction techniques, including deep breathing exercises and mindfulness meditation, to manage her physical symptoms of anxiety.
    • Lifestyle Modifications: Sarah was encouraged to maintain a balanced diet, engage in regular physical activity, and establish a consistent sleep routine to support overall well-being.
  • Over several months of therapy and stress management, Sarah’s symptoms gradually improved.
  • She reported reduced worry, enhanced ability to concentrate at work, and better sleep quality.
  • Sarah continued with regular follow-up appointments with her therapist to maintain her progress and refine her coping skills.
  • Sarah’s case highlights the role of CRH dysregulation in the pathophysiology of generalized anxiety disorder (GAD).
  • The heightened cortisol response to stress observed in hormonal testing suggests an overactive HPA axis, contributing to her anxiety symptoms.
  • A multifaceted treatment approach, including psychotherapy and stress management techniques, was effective in helping Sarah regain control over her anxiety and improve her quality of life.

This case study illustrates the clinical presentation, diagnosis, and treatment of a patient with generalized anxiety disorder, emphasizing the potential role of CRH dysregulation in the development and maintenance of anxiety-related hormonal disorders.

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